Increasing the yield of the high-resolution anoscopy with endoscopic assistance: A Gastroenterologist’s Perspective

Background: There is an increase in the rates of the Human Papilloma virus (HPV) related anal cancer in human immunodeficiency virus (HIV) positive individuals. The anal dysplasia screening is offered to the individuals at risk and anal cytology is one of the screening modalities. High resolution anoscopy (HRA) is performed for the further evaluation of the abnormal anal cytology. HRA plays a key role in the identification and management of high-grade squamous intraepithelial lesion (HSIL). Yield of HRA to detect HSIL in patients with HSIL on anal cytology can be affected with factors like difficult anal anatomy and use of microscope respectively. Acquiring HRA skills and using a microscope to increase the yield has a steep learning curve, and hence leaving most gastroenterologists untrained in this examination.